Laparoscopic or minimally invasive surgery includes the use of several relatively small ports into the abdomen by which different types of instrumentation and accessories are introduced and used for different surgical interventions (usually performed under endoscopic vision). Although usually considered superior in several aspects to open surgery, the use of a plurality of 5 to 15 mm ports still leads to local pain, scars, and possibly port related complications such as hernia in scars and the need for one or two assistants in addition to the surgeon.
In past years, new versions of laparoscopic systems and approaches were introduced to overcome several of the “classic” laparoscopy disadvantages, mainly the Single-Port Access (SPA) and the Needlescopy approaches. In SPA the surgeon operates almost exclusively through a single entry point, typically through the patient's navel, using access ports and hand instrument. Highly experienced and skilled physicians may still use standard laparoscopic hand instruments, although the use of a single port access decreases its triangulation and complicates maneuverability. The use of special-purpose articulating instrumentation was introduced to overcome this difficulty, although it is considered very expensive, necessitates special training and still involves complex surgical maneuverability.
“Minilaparoscopy” (also known as “needelscopic laparoscopy”) is intended to overcome the problems encountered in single port access surgery. While the advantages of SPA include improved cosmetic, less abdominal wall pain and less incision related complications, this surgical approach has disadvantages. The vision is partially obscured by the paralleled inserted instruments; there is minimal triangulation and limited maneuverability of the surgical instruments. Minilaparoscopy maintains the same mode of surgery as standard laparoscopy however there is only one sheath and all the rest of the instruments are connected to needle-like shafts which are inserted with no trocar and therefore provide comparable cosmetic and painless results as SPA.
In needlescopy, the laparoscopic ports are replaced with small incisions, usually between 2 to 3 mm in diameter. The surgery is performed by inserting narrow guide tubes into the small incisions and then passing tiny instruments through the tubes, while using a small camera for guidance. The small instruments have very slender tips which make dissection and tissue maneuvering very difficult. Furthermore the instrument tips may have a greater tendency to break and their removal may be cumbersome and difficult.
In order to avoid such difficulties while maintaining small incision porting, it has been advised to combine the single-port and the needlescopic approaches. This is achieved by first inserting regular-sized interchangeable end-effectors through a regular size single port access and then detachably attaching them to corresponding distal portions of needle-sized manipulators. The manipulators are protruding into abdomen cavity via miniature needlescopic type incisions. Locating and engaging between a needle manipulator and an end-effector inside the abdominal cavity may be risky and cumbersome, therefore the Inventors suggest that such engagement and connection will take place in a more secured location such as outside the abdominal cavity or even outside patient's body.